pain/inflammation

Question 1

afferent pathway

Answer 1

sensory information from PNS to CNS
- afferent

Question 2

nociceptors

Answer 2

located in skin, bones, blood vessels, visceral organs

Question 3

pain pathway

Answer 3

stimulus –> nociceptors –> 1st order neuron (A or C fibres) –> dorsal root and ganglion –> substance P –> 2nd order neuron- decussates–> white mater –> thalamus –> 3rd order neuron –> somatosensory cortex–> effect

Question 4

endogenous opioid peptides

Answer 4

inhibitory neurotransmitters
- endorphins
- released from hypothalamus and limbic system
- descending pathway
- inhibit substance

Question 5

reduction of pain sensation

Answer 5

secretion of serotonin and norepinephrine

Question 6

pain treatment

Answer 6

stops pain signal transmission

Question 7

non-opioid centrally acting agents

Answer 7

stop pain signal transmission at CNS level
- acetaminophen, opioids

Question 8

NSAID’s

Answer 8

stop pain signal transmission at peripheral level

Question 9

pain rated 4/10

Answer 9

give non-opioid medications
- NSAID, tylenol

Question 10

pain rated 4-6/10

Answer 10

give opioids
- codeine, morphine

Question 11

pain rated greater than 6/10

Answer 11

higher potency opioids

Question 12

acetaminophen

Answer 12

centrally acting analgesic
- PO, antipyretic, high efficacy

Question 13

opioids

Answer 13

centrally acting analgesics
- agonist for mu, kappa, and delta receptors
- inhibits substance P release

Question 14

fentanyl, hydromorphone, meperidine, morphine, methadone

Answer 14

high efficacy opioids

Question 15

hydrocodone, oxycodone, oxycontin, tramadol

Answer 15

moderate efficacy opioids

Question 16

percocet, percodan, vicodin, tramacet

Answer 16

combo opioids

Question 17

codeine

Answer 17

combo opioid, unreliable bioavailability

Question 18

analgesia receptor side effects

Answer 18

sedation, nightmares

Question 19

dopamine receptor side effects

Answer 19

euphoria, psychological dependence

Question 20

histamine receptor side effects

Answer 20

pruritus, decreased GI, urinary retention

Question 21

naloxone (narcan)

Answer 21

treatment of opioid overdose
- quick onset of action, lasts 45 min

Question 22

anti-inflammatory drugs

Answer 22

stop prostaglandin synthesis through COX inhibition

Question 23

inflammation

Answer 23

synthesis of prostaglandins from arachidonic acid to produce inflammatory process

Question 24

COX 1

Answer 24

present in all tissues
- protects gastric mucosa, supports platelet aggregation
- undesirable inhibition

Question 25

COX 2

Answer 25

present at sites of tissue injury - mediates inflammation, mediates fever - desirable inhibition

Question 26

celecoxib

Answer 26

selective COX 2 anti-inflammatory - cardiovascular related complications - black box warning

Question 27

ASA (aspirin), Ibuprofen, diclofenac, naproxen, ketorolac

Answer 27

non selective COX inhibitors

Question 28

glucocorticoids

Answer 28

"one"; steroidal, endogenous, lipophilic, nuclear receptor binding, secreted from adrenal cortex - potent, high efficacy

Question 29

glucocorticoid effects

Answer 29

stimulates gluconeogenesis, low muscle, high blood glucose, COX 2 inhibition, suppression of histamine release

Question 30

hydrocortisone, prednisone, dexamethasone

Answer 30

glucocorticoids - lipophilic, highly PPB

Question 31

dexamethasone

Answer 31

used for systemic inflammation - autoimmune, anaphylaxis, joints

Question 32

budenoside, fluticasone, mometasone

Answer 32

used for allergic rhinitis

Question 33

pulmicort, Qvar, flovent

Answer 33

used for asthma

Question 34

asthma prevention medications

Answer 34

glucocorticoids, leukotriene modifiers, mast cell stabilizers

Question 35

asthma rescue medications

Answer 35

bronchodilators, anticholinergics, epinephrine

Question 36

anticholinergics

Answer 36

inhibits PNS; atrovent - bronchodilator, anti ACH

Question 37

atrovent

Answer 37

anticholinergic

Question 38

histamine

Answer 38

primary mediator of sensory stimulated inflammation - stored in mast cells and released when cell comes in contact with allergen

Question 39

histamine location

Answer 39

smooth muscle of vascular system, digestive tract, bronchial tree, CNS

Question 40

antihistamines (H1 antagonists)

Answer 40

"ine"; antagonizes H1 receptors

Question 41

first gen antihistamines

Answer 41

crosses BBB, CNS side effects

Question 42

diphenhydramine (benadryl), chlorpheniramine (benylin)

Answer 42

first gen antihistamines

Question 43

second gen antihistamines

Answer 43

decreased CNS distribution

Question 44

claritin (loratadine), reactin (cetirizine)

Answer 44

second gen antihistamines

Question 45

antitussives

Answer 45

cough treatment - CNS depression of cough reflex - codeine

Question 46

adrenergic agonists

Answer 46

"edrine"; treat congestion - SNS stimulation causing decreased nasal secretions - ephedrine, pseudoephedrine

Question 47

ephedrine

Answer 47

adrenergic agonist